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Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

2021; BioMed Central; Volume: 21; Issue: 1 Linguagem: Inglês

10.1186/s12872-021-02019-0

1471-2261

José María Mostaza, Carmen Suárez, José María Cepeda, Luís Manzano, Demetrio López Sánchez, Fernando Javier Sánchez Lora, Francisco Ibañez Bermúdez, Ana María Jurado Porcel, Fernando Salgado Ordóñez, Francisco Rivera Civico, Díez García F, Fernando Jaén Águila, Manuel Geraldía Lama, Enrique Peral Gutiérrez-Ceballos, Antonia Domínguez, Francisco Astudillo Martín, Eduardo Aguilar, Juan Ferrando Vela, Alfonso García Aranda, Mercedes Sánchez Cembellín, Juan Francisco López Caleya, S Berenguer-Ruiz, Melchor Rodríguez Gaspar, Alicia Conde‐Martel, José L. Hernández, Ismael Abascal Carrera, A. Castellanos, E. Fernández Pérez, Juan Carlos Martínez Acitores, Luis Miguel Seisdedos Cortes, Laura Abad Manteca, Marco Budiño Sánchez, José Javier Moreno Palomares, Inmaculada Coca Prieto, Ana Isabel Muñoz, Ángel Sánchez Castaño, Lola Ruiz Ribó, Jordi Mascaró, César Morcillo Serra, Teresa Auguet, Francesz Marimón, J. Solà, José María Suriñach, Pablo Javier Marchena, Antoni Riera‐Mestre, Pedro Armario, Ferrán García Bragado, Fátima del Molino, O. Martı́nez, Pere Almagro, C. Falgá, J. Apolinar Muñoz Rodríguez, Riesco, Jorge Romero Requena, José Carlos Arévalo‐Lorido, Manuela Chiquero Palomo, A Cruz, Agustín Pijerro, Elena Fernández Bouza, Juan José González Soler, Manuel Jesús Núñez Fernández, Javier de la Fuente Aguado, José Antonio Díaz Peromingo, Julián Fernández-Martín, Rafael Daroca Pérez, Jesús Castiella Herrero, M.C. Carreño, Jorge Gómez Cerezo, José Carlos Pontes Navarro, José F. Varona, Daniel Ferreiro López, Benjamín Muñoz Calvo, J. Casado, María del Pilar Fidalgo Montero, José Manuel Casas Rojo, B. Herreros, Guillermo Cuevas, Antonio Muiño Míguez, Jorge Marrero Francés, Nicolas M. Ortega, Javier Trujillo, Julio Sánchez Álvarez, Jose Ignacio Catalán Ramos, Francisco Javier Fresco Benito, Ainhoa Anuzita Alegría, Carlos Teruel, Arturo Artero, Pedro Moral, José Miguel Seguí Ripoll, Fernando Bonilla Rovira, Ana Maestre Peiró,

Venous Thromboembolism Diagnosis and Management

Abstract Background This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.